The Politics of Health Inequity: Public Narrative and Social Justice

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1 The Politics of Health Inequity: Public Narrative and Social Justice Richard Hofrichter, PhD Senior Director Health Equity and Social Justice NACCHO Washington, DC

2 Politics and Health The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart. Geoffrey Rose Source: The Strategy of Preventive Medicine. Oxford: Oxford University Press 1992, p. 129.

3 Public Health and Social Change When the history of public health is seen as a history of how populations experience health and illness, how social, economic, and political systems structure the possibilities for healthy or unhealthy lives, how societies create the preconditions for the production and transmission of disease, we find that public health history pervades every aspect of social and cultural life. Hardly surprisingly, these questions direct attention to issues of power, ideology, social control, and popular resistance. Source: Elizabeth Fee, introduction to A History of Public Health, George Rosen, (1993)

4 The Class System vs. Communities WHAT THE CLASS SYSTEM DEMANDS Low wages Flexible, mobile labor force Immunity from social damage Higher productivity and efficiency, total control of work process WHAT COMMUNITIES NEED A living wage, paid sick days Stable social and community life Accountability for social damage Improved working conditions and control over the work process

5 The Class System vs. Communities WHAT THE CLASS SYSTEM DEMANDS Docile, Disciplined Labor Force Ownership and control of productive resources Free flow of capital Economic growth; satisfying investors WHAT COMMUNITIES NEED Autonomy; control of the work process Democratic control of life s necessities; public resources Economic security Well-being, meeting human needs

6 STRUCTURAL RACISM & HEALTH INEQUITY

7 Dominant Narrative At Work On Public Radio WORK PLACE Car Talk WORKER WEEK Wall Street Week PUBLIC TRANSPORTATION TALK

8 Euphemisms Corporate Language Discipline Soil Killed Economic Recovery Privatization Austerity Obedience Real Meaning Privately Owned Property Murdered Recovery of Profits Corporate Takeover of Public Services Class War and Increase in Inequality Source: James Petras, The Politics of Language and the Language of Political Regression, Dissident Voice (May, 2012).

9 Euphemisms (Continued) Corporate Language Market Discipline Market Demands Wage Cuts Market Shock Free Market Real Meaning Exploitive and Predatory Behavior Exploitation of Workers Abrupt Firings; Slashing Pensions and Health Plans No Regulation for Worker Safety, Health, Environment Source: James Petras, The Politics of Language and the Language of Political Regression, Dissident Voice (May, 2012).

10 Market vs. Democracy Market Production decisions: whatever is profitable Decisions are private Overall goal: no social goals Promotes interventions through health services Market discipline Democracy Production decisions to meet human need Socially directed investment Goal: Flourishing Human Existence Promotes public works for social change Taking advantage of unemployed workers

11 Obscuring Reality in a Narrative A large corporation fires thousands of people and moves jobs overseas. Explanation: The market forced its hand A large real estate firm gets a loan from a bank to purchase land for a 40-story office building requiring displacement of thousands of residents. Explanation: It s good for economic growth Banks make sub-prime loans as part of a process that leads to the greatest economic crisis since the Great Depression. Explanation: Banks exercised too much risk and made mistakes

12 Example of the Dominant Narrative in Public Health Differences in health based on race, ethnicity, or economics can be reduced, but will require public awareness and understanding of which groups are most vulnerable, which disparities are most correctable through available interventions, and whether disparities are being resolved over time. These problems must be addressed with intervention strategies related to both health and social programs, and more broadly, access to economic, educational, employment, and housing opportunities. Source: CDC Health Disparities and Inequalities Report. MMWR January 14, 2011

13 Revised Version Differences in health based on racism or class oppression can be eliminated, but will require exploration of which groups are made vulnerable by social injustice, which inequities can be eliminated through organized efforts. These injustices must be confronted with strategies related both to transforming political power and more broadly addressing the contradictions and gaps within the power structure that give rise to poor living and working conditions.

14 Politics of Public Health Language Conventional Vulnerable population Risk factors Factors Social determinants of health Intervention Health Equity Populations under threat Social responsibility for risk Causes of health equity of health inequity Social change

15 Local Indicators: Identifying Generators of Health Inequity Allocation of city budget by neighborhood Levels of gentrification Investment in local infrastructure Level of housing and school segregation Transfer of public services to large scale corporate enterprises Siting hazardous waste facilities by neighborhood

16 Foreclosure Affects Health Source: Just Cause & Alameda County Public Health Department

17 Minnesota Department of Health Changes the Narrative

18 Local Public Health in Action Assumptions Structure/Content Observation/Outcomes Source: Ingham County Health Department

19 Community Organizing

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21 The Politics of Health Inequity: Public Narrative and Social Justice Questions?